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PubMed2004

Obstetrics and gynecology residents' attitudes toward maternal-fetal medicine fellowship training.

OBJECTIVE: To assess factors associated with residents' decisions to pursue or forego fellowship training in maternal-fetal medicine (MFM). METHODS: A survey utilizing multiple-choice, Likert, ordinal and categorical scale questions was distributed to all (n = 2337) postgraduate year (PGY) 3 and 4 obstetrics and gynecology residents in accredited US training programs during the 2001-02 academic year. The 18-question survey sought demographic and residency training details, quality of interactions with the MFM faculty and fellows, and information about 13 specific factors that might influence a resident's decision to pursue MFM training. RESULTS: Surveys were returned by 642 (27%) residents, equally divided between PGY 3 and 4. Only 90 (14%) residents reported either ongoing consideration of, or having already applied for, MFM training (MFM group), while 278 (43%) had considered MFM training, but chose to either stay in general practice or pursue another fellowship (neutral group). The remaining 274 (43%) reported never having considered MFM (never group). The three groups were similar with regard to demographic characteristics and residency training; however, the MFM group ranked the quality of teaching by the MFM faculty significantly higher than the neutral and never groups. Encouragement by the MFM faculty, salary during fellowship and the 3-year (as opposed to 2-year) duration were reported to be the strongest influencing factors and were significantly different from ten other factors considered in the survey (p < 0.05). CONCLUSION: Major positive factors influencing the pursuit of MFM training are the quality of educational experiences and encouragement from the MFM faculty. Conversely, the duration and the perceived financial burden of the 3-year training program appear to be significant deterrents.

Adult↗
PubMed1994

Critical care training makes trauma care more attractive as a career.

One recent report has prompted concern that surgical residents are no longer concerned in providing trauma care as a significant portion of their careers. In 1986, we linked our trauma and critical care services. We surveyed all chief residents who finished in the past 10 years, comparing the 5 years before the linking of trauma and critical care to the period since. Between 1982 and 1987, 3 of the 45 finishing residents (7%) pursued trauma fellowships, then trauma care as a career. Since 1987, 12 finishing residents (30% of the total and 33% of those pursuing fellowship training) trained in trauma/critical care. Nine currently pursue trauma care as a career. Two others are academic trauma surgeons without fellowship training and one other practices general surgery with trauma care as a main focus. Thus 12 of the 41 residents (30%) practice trauma care and 14 residents (34%) practice critical care. Residents finishing since 1987 were significantly more likely to respond that they are interested in trauma care, feel trauma care was attractive, and wish to have trauma care be a major portion of their careers. Those who chose not to pursue trauma care cited reasons similar to those described by Richardson and Miller. Other specialty interests were the most important factor in both time periods. Residents finishing after 1987 described the link between trauma care and critical care with a designated ICU service as strong positive influences. The understanding of resuscitation physiology gained in the ICU, including nonsurgical therapy, was felt to enhance trauma care, making it more attractive.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Choice↗
PubMed1988

Obstetric ultrasound training for family physicians. Results from a multi-site study.

A practical program to train family physicians in obstetric ultrasound was tested with 13 family physicians. Each physician completed 6.5 days of course work and ultrasound laboratory apprenticeship prior to beginning a clinical preceptorship of approximately 14 months' duration. During the clinical preceptorship the physicians performed ultrasound studies in their own offices. All studies were reviewed by a local consultant radiologist utilizing examination data sheets and videotapes. At the conclusion of the training program, the physicians took a combined practical and written proficiency examination administered by an independent sonographer. Eight physicians completed the training, performing during the preceptorship an average of 78 examinations. The rated performance of the physicians improved markedly over the course of the preceptorship. During the last segment of the preceptorship the radiologist preceptors rated 94 percent of the ultrasound studies as acceptable, compared with 79 percent rated acceptable at the beginning of the preceptorship. Seven of the eight physicians completing the protocol took the proficiency examination: all passed. This study can provide a blueprint for an individual family physician to design his own training, or it can guide an academic department of family medicine in developing and evaluating ultrasound training programs for residents and practicing physicians.

Education, Medical, Continuing↗
PubMed1998

William Fulton Gillespie, 1891-1949: transitional figure in western Canadian academic surgery.

The professional life of William Fulton Gillespie, third professor of surgery at the University of Alberta (1939-49) and tenth president of the Royal College of Physicians and Surgeons of Canada (1947-49), exemplifies a critical transitional period in Canadian postgraduate surgical training and in western Canadian academic surgery. This article explores the background, the training, the professional career, and the personal character of a surgical scholar and student of the humanities and arts, a man who was thrust into the professorship of surgery in a maturing western Canadian medical school following the financial restraints of the Great Depression and during the challenges faced as a result of the World War II.

Academic Medical Centers↗
PubMed2004

Child neurology training via the research pathway: outcome study.

This article describes a residency training track that was developed by the American Board of Psychiatry and Neurology to promote the career development of child neurologists who wanted to become researchers. In this pathway, 1 year of research in the basic neurosciences replaces 1 year of pediatrics or internal medicine. Since 1992, 38 residents from more than 20 training programs have been accepted into this pathway. Of the 28 who have completed residency training, 22 are in academic positions as faculty or fellows, and 6 are working in nonacademic hospital settings. Of these 22, 6 describe their research as basic, and 12 describe their research as being both basic and clinical; 15 have been successful in obtaining external funding. Thus far, these trainees have published more than 125 articles in peer-reviewed journals. Although small in scope, this training track has met its objective of producing clinician-scientists.

Child↗
PubMedDate not supplied

Mentoring partnerships for minority faculty and graduate students in mental health services research.

OBJECTIVE: The authors developed mentorship programs to train minority junior faculty and advanced graduate students in mental health services research. METHOD: The programs target "mentees" in the Southwest United States and offer long-term mentoring, seminars, group supervision, seed funding for peer reviewed research proposals, peer interaction, and week-long institutes that feature presentations and mentoring by recognized experts. RESULTS: Evaluations suggest that these programs have influenced participants' career development. Most mentees have continued to evolve in their research careers, submitted research grant applications, and obtained postdoctoral fellowships, and/or have advanced in faculty positions. Some mentees have expressed an opinion that without the support network that these programs provided, they would have abandoned their academic careers. CONCLUSIONS: Future training efforts should take into account a series of challenges and tensions that affect mentees' careers and personal lives, including the emotional legacy of discrimination and historical trauma.

Academic Medical Centers↗
PubMed1992

Professional qualifications of the membership of the British Association of Oral and Maxillofacial Surgeons.

The medical and higher academic qualifications of the current membership of the British Association of Oral and Maxillofacial Surgeons were analyzed. Of the total membership, 69.3% possessed a postgraduate dental fellowship, 28.3% held a formal medical qualification and 16.5% held a higher academic degree. Half (45.9%) of the Fellows (Consultants), one-third (28.1%) of the Members and one-tenth (10.9%) of the Associate Members were medically qualified. Consultants in NHS positions and Members in higher training grades accounted for the majority of medically qualified individuals. Higher academic qualifications were held by one-fifth (20.8%) of Fellows, one-tenth (11.4%) of Members and one-fifth (17.7%) of Associate Members. Most of those possessing higher academic qualifications were consultants in University appointments, Members not in training and overseas Associate Members. A dental basis for the specialty was upheld by the finding that 99.7% of Fellows held a post-graduate dental fellowship. These results are discussed in relation to current recommendations for clinical and academic training in oral and maxillofacial surgery in the UK.

Dental Staff, Hospital↗
PubMed1977

A community neurologist's personal viewpoint on neurological training.

A study of 200 patients referred to a community neurologist showed that 87.5% of the patients were seen in the office and only 12.5% in hospital. Neurological signs were present in 52% and 28.5% had neurological signs which materially affected the diagnosis. A questionnaire sent to several teaching centers showed that only one center sent students and residents to community neurologists' offices at all and in most centers the resident spent just 10 to 20% of his time seeing out-patients. It was felt that the balance of in-patient/out-patient teaching for students and residents was wrong, and that more emphasis should be placed on the neurological history than on the examination. Proposals are made to involve the community neurologist as well as the academic neurologist in the training of students and residents which would benefit all four groups.

Canada↗
PubMed1993

Factors associated with research efforts of academic family physicians.

BACKGROUND: Family medicine has struggled to gain stature among academic medical disciplines. One factor has been the paucity of quality family medicine research. METHODS: Two hundred eight full-time physician faculty members at family practice residency programs completed a survey that focused on demographics, training, experience, professional activities, and factors that motivated them to select academic careers. Bivariate and multivariate analyses were performed to determine if any of these factors was associated with increased time spent on research. RESULTS: Faculty members who spent 10% or more of their professional time on research were more likely to be fellowship trained, employed in university training programs, have more academic experience, and to cite the opportunity to do research as a factor motivating them to enter academic medicine. However, when multivariate analysis was performed, the only significant factor that predicted that a faculty member would devote 10% or more time to research was having an interest in research when first seeking a position in academic medicine. CONCLUSIONS: The amount of time that family medicine faculty members dedicate to research is related to a strong interest in research when seeking their academic position. Fellowship training and an academic environment may have assisted faculty in performing research, but were not independent predictors of future involvement in research.

Academic Medical Centers↗
PubMed1996

Attitudes and expectations of 1995 gastroenterology graduates about gastroenterology.

OBJECTIVE: To learn more about current attitudes and expectations of recent (June 1995) graduates of gastroenterology fellowship programs, why they chose either a private practice or academic career, and what impact managed care or health care reform had in their decision. METHODS: Between April and June 1995, and 8-page, 35-question survey questionnaire was mailed to graduating fellows and returned for evaluation. RESULTS: Graduates believed managed care had an impact on job availability, but it was not a factor in their job choice. Forty percent of the respondents reported that finding a job was either difficult or very difficult. The majority of respondents (67%) are pursuing a career in private practice. Most private practice physicians (PP) trained in 2-yr programs whereas academic physicians (AC) trained for the most part in 3-yr programs. The principal criteria on which decisions regarding job selection were based were similar between the two groups: co-workers, geographic location, access to patient care, and ability to perform endoscopy. Respondents in PP and AC expected to work 50-70 h/wk, care for patients with similar diseases, and have ample time for family. They would choose GI again as a career and believed that there is a future in GI. Salary expectations varied markedly between the two groups, and AC physicians were more concerned about their future financial needs. Twenty percent of PP physicians and 71% of AC physicians plan to participate in clinical research. CONCLUSIONS: Recent graduates of gastroenterology fellowship programs continue to have high expectations of their future careers. Although some had difficulty finding a job and stated that, although managed care had an impact on the job market, it had not yet become a major factor in their job selection.

Adult↗
PubMed1984

Substance misuse training in graduate psychology programs.

A total of 436 graduate psychology training programs, including both academic and internship programs, were surveyed to determine the extent to which they included issues of substance misuse in their curricula. The survey consisted of a 37-item questionnaire and a multiple-mailing methodology that yielded a 78% response rate. The results indicate that a majority of programs provide students with at least some exposure to substance misuse issues, that programs focus both on alcoholism and on misuse of other drugs, that misuse is considered from several different combinations of perspectives (theory, research and treatment), and that both abstinence and moderation training are included in many curricula as potential goals of treatment. Additionally, data are presented on locations of training, measurement of student competence, professional involvement of faculty and staff members in the area of substance misuse, and plans that programs are making for future research and training activities. The role of psychology in general in the provision of substance misuse training is also discussed.

Counseling↗
PubMed1991

Public-academic linkages for culturally sensitive community mental health.

This paper traces the sixteen year history of a unique community mental health center which has combined academic and service provider roles in delivery of culturally appropriate care. Initially an arm of a department of psychiatry and derived from an anthropological research project, the center model was based on seven teams serving discrete ethnic communities, with subsequent development of a network of neighborhood-based "mini-clinics" as well as centralized aftercare facilities. The team staff-social scientists, clinicians, and paraprofessionals all of matching ethnicity to the populations served-became a core of "culture brokers" with a service, teaching, and research role at the interface of the university, medical center, and community. Subsequently the university was funded for a cross-cultural training institute for mental health professionals. Center staff extended training in culturally appropriate care to 174 mental health professionals from 97 facilities throughout the nation, as well as other spinoffs improving cultural expertise of staff in public sector agencies. Data on effectiveness of services and training are given and significant findings are discussed. The description includes the impact of historical shifts in funding, the effects of external events on community mental health center structure, and the current state of cross-cultural training and public-academic linkages in this particular program.

Aftercare↗
PubMed2004

Mission statements: what do they tell us about family medicine training programs?

OBJECTIVES: Family medicine is the second largest medical specialty in the United States; yet, some argue that it is struggling to define itself. This study examined mission, vision, and goal statements of family medicine residency programs as a means of gaining insight into the current definition of the discipline. METHODS: Mission statements were obtained from the Internet sites of family medicine residency programs or requested directly from programs when the mission statements were not available on the Internet. The content of the mission statements was analyzed for the presence of eight categories of family medicine values that were identified through a literature review. RESULTS: We obtained mission statements from 296 of 472 (63%) residency programs. No significant relationships were found between program characteristics and the number or types of values found in the mission statements. The following three categories of family medicine values were named in at least 70% of mission statements: (1). community issues, (2). academic mission, and (3). quality health care. In contrast, the words "family" and "research" were mentioned by only one third of programs. CONCLUSIONS: Community-oriented care was mentioned more often than family-centered care. Despite the mention of academic missions by many training programs, most lacked a stated interest in research development. Although quality health care was named in the majority of mission statements, keeping current with technology was not. These findings contribute unique information that may be useful in the evolving definition and discussion of family medicine.

Community Health Services↗
PubMed1995

Family medicine residents' knowledge and attitudes about drug-nutrient interactions.

OBJECTIVE: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that health professionals recognize the importance of drug-nutrient interactions and educate patients to prevent adverse effects. Drug-nutrient interactions are an important issue in medical practice, but it is not clear how or if physicians are trained in this issue. METHODS: This investigation was a needs assessment that examined attitudes and knowledge about drug-nutrient interactions that was examined in a national sample of 834 family medicine residents in 56 residency programs. RESULTS: Most reported they had little or no formal training in drug-nutrient interactions in medical school (83%) or residency (80%). However, 79% believed it was the physician's responsibility to inform patients about drug-nutrient interactions, although many thought pharmacists (75%) and dietitians (66%) share this responsibility. Overall, residents correctly answered 61% +/- 19 of fourteen drug-nutrient interaction knowledge items. There was a slight increase in drug-nutrient knowledge as year of residency increased. CONCLUSIONS: Physicians' knowledge of drug-nutrient interactions may be improved by including nutrition education in the topics taught by physicians, nutritionists, and pharmacists using several educational strategies. Nutrition educators in particular can play a role in curriculum development about drug-nutrient interactions by developing, refining, and evaluating materials and educational tools. Nutrition educators need to provide this information in academic settings for the training of all health professionals as well as in patient education settings such as hospitals and public health clinics.

Education, Medical↗
PubMed1998

The Morehouse Faculty Development Program: methods and 3-year outcomes.

BACKGROUND AND OBJECTIVES: Faculty development is an established method for increasing the number and effectiveness of faculty in family medicine. However, few published studies focus specifically on the use of faculty development to increase minority representation among faculty. Underrepresented minorities comprise 20% of the nation's population but only 3% of medical school faculty. In the entire nation, only 52 full-time teachers of family medicine are African-Americans. Morehouse School of Medicine has developed an effective model for training large numbers of underrepresented minority physicians to become academic family physicians. From 1993-1996, we trained 23 community-based physicians, three new faculty, six existing faculty, and three full-time fellows as teachers of family medicine. Of 35 participants, 33 were underrepresented minorities. Cultural issues in teaching and communication are an integral part of the curriculum. Seventy-three percent of graduates now teach medical students or residents either full-time or part-time. Further studies are needed to test the replicability of this model in non-minority institutions, as well as to achieve greater cost-effectiveness and improve academic outcomes such as publications and research. Significant faculty diversity is necessary and achievable, if institutions are willing to commit significant resources and network with minority health professionals and institutions.

Black or African American↗
PubMed1998

Upstairs downstairs: vertical integration of a pediatric service.

BACKGROUND: The combined effects of recent changes in health care financing and training priorities have compelled academic medical centers to develop innovative structures to maintain service commitments yet conform to health care marketplace demands. In 1992, a municipal hospital in the Bronx, New York, affiliated with a major academic medical center reorganized its pediatric service into a vertically integrated system of four interdependent practice teams that provided comprehensive care in the ambulatory as well as inpatient settings. One of the goals of the new system was to conserve inpatient resources. OBJECTIVE: To describe the development of a new vertically integrated pediatric service at an inner-city municipal hospital and to test whether its adoption was associated with the use of fewer inpatient resources. DESIGN: A descriptive analysis of the rationale, goals, implementation strategies, and structure of the vertically integrated pediatric service combined with a before-and-after comparison of in-hospital resource consumption. METHODS: A before-and-after comparison was conducted for two periods: the period before vertical integration, from January 1989 to December 1991, and the period after the adoption of vertical integration, from July 1992 to December 1994. Four measures of inpatient resource use were compared after adjustment for case mix index: mean certified length of stay per case, mean number of radiologic tests per case, mean number of ancillary tests per case, and mean number of laboratory tests per case. Difference-in-differences-in-differences estimators were used to control for institution-wide trends throughout the time period and regional trends in inpatient pediatric practice occurring across institutions. Results. In 1992, the Department of Pediatrics at the Albert Einstein College of Medicine reorganized the pediatric service at Jacobi Medical Center, one of its principal municipal hospital affiliates, into a vertically integrated pediatric service that combines ambulatory and inpatient activities into four interdependent practice teams composed of attending pediatricians, allied health professionals, house officers, and social workers. The new vertically integrated service was designed to improve continuity of care for patients, provide a model of practice for professional trainees, conserve scarce resources, and create a clinical research infrastructure. The vertically integrated pediatric service augmented the role of attending pediatricians, extended the use of allied health professionals from the ambulatory to the inpatient sites, established interdisciplinary practice teams that unified the care of pediatric patients and their families, and used less inpatient resources. Controlling for trends within the study institution and trends in the practice of pediatrics across institutions throughout the time period, the vertical integration was associated with a decline in 0.6 days per case, the use of 0.62 fewer radiologic tests per case, 0.21 fewer ancillary tests per case, and 2.68 fewer laboratory tests per case. CONCLUSIONS: We conclude that vertical integration of a pediatric service at an inner-city municipal hospital is achievable; conveys advantages of improved continuity of care, enhanced opportunities for primary care training, and increased participation of senior clinicians; and has the potential to conserve significant amounts of inpatient resources.

Academic Medical Centers↗
PubMed2004

General practice east of Eden: an overview of general practice in Eastern Europe.

AIM: To review the status of family medicine in Eastern European countries, specifically the position of the discipline within the health care system, its academic status, and expected trends in the development of the discipline. METHODS: We used available data in the literature and information gathered from personal contacts with members of European Society of General Practice/Family Medicine (ESGP/FM) expert groups, European Academy of Teachers in General Practice (EURACT), and European General Practice Research Network (EGPRN). Personal interviews with key informants from countries that do not have members in these organizations were used. We also performed a Medline search using terms "primary health care" and "family medicine". RESULTS: It was difficult to get standardized information about the issues addressed. In some countries, contact persons and articles were impossible to find. Because of that, information from some countries is lacking (e.g. Belarus, Ukraine, the Kavkaz states and Central Asian republics). The information from the 14 countries showed that family medicine was formally widely recognized as a specific discipline. In 13 of them, there were some programs of vocational training. In 10 countries, academic recognition has resulted in rapid development in the past two decades, especially after 1989, but in Bulgaria and Moldova we found no evidence of family medicine departments. CONCLUSION: The position of general practice in most Central and Eastern European countries is formally adequate, but a lot of effort will still be needed to achieve the desired level of its recognition and quality.

Europe, Eastern↗
PubMed2005

Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics.

BACKGROUND: The objectives of this study were to compare educational and social outcomes for young survivors of childhood cancer with a population control group of individuals who were never diagnosed with cancer and to identify risk and protective factors for these outcomes. METHODS: In this multicenter, Canadian, retrospective cohort study, 800 survivors age 17 years or younger were matched by age and gender with a group of 923 control participants. Using a mailed survey that was completed by parents, educational outcomes were assessed with questions about the child's enrollment in disability or special-education programs, repeating a grade, and academic or other school problems. Using friendships was the measure of social outcomes. RESULTS: Based on parental reports, significantly more survivors than controls repeated a grade (21% vs. 9%), attended learning-disability (19% vs. 7%) or special-education programs (20% vs. 8%), had educational or other school problems (46% vs. 23%), had no close friends (19% vs. 8%), and were less likely to use friends as confidants (58% vs. 67%). Survivors of central nervous system (CNS) tumors reportedly were more likely than controls to have educational problems and no close friends, followed by survivors of leukemia, and survivors of neuroblastoma. Among survivors, cranial radiation increased the likelihood of having educational difficulties and having no close friends compared with survivors who did not receive cranial radiation. Survivors who reportedly had high self-esteem and whose parents had postsecondary education had fewer educational and social problems. CONCLUSIONS: Children and adolescents who survived cancer, particularly those who had CNS tumors, leukemia, and neuroblastoma, required close monitoring for early educational and social difficulties, and such children should be offered educational rehabilitation and social skills training to maximize their academic and social success.

Adolescent↗